| 12/28/2016 |
| 08:10:31 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| LEWANDOWSKI, MA, | LV-002203 | R | 79.80 | 4308********3362 | 620739 | 12/28/16 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 79.80 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 79.80 |